HomeMy WebLinkAboutMortgage_McCammon 4Z STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Fist
FOR DEDUCTION FROM ASSESSED VALUATION �,
I: State Form 43709(R11/6-09)
Prescribed by Department of Local Government Finance
INSTRUCTIONS:
File tv29 2014
To be filed in person or by mail with the County Auditor or County Recorder of the county where the properly is located. Form Ned -
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. ..�• - ,
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months n' ' y •eon..
before March 31 of each year the deduction is sought G BS i Gt4 ' ""=r6Q,5ITo R
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See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restitutions on reve side) �J
C C—/-�`A ac.. -Jh )"`�1"1-'�1St1 ^ a A-['rs17 i `Kk Jt�E� r plefrecord Taring D SISZQt�Key number/legal a. dti- ta _ IDra - onth_ tieL,-b; O UU Page
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Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebteness unpaid as of Is the applicant the sole
March 1,nxnert year MMaartm33n1 1,arnent year date of appfuatbn legal or equitable owner?
If no,what is his/her exact share of interest? If owned with someone other than spouse,udfcate with whom I ❑ No
If name on record is ddferent than that of applicant indicate below Is the property in question:Annually Assessed
‘rpReal Property ❑Annually Assessed
• Mobile Hane(IC 6-1.1-7)
Name ee or contract s ,� f�
�`\\\\YYAddress of mortgagee or contract seller(n mrbert and stree� t,city.slate,and ZIP code)
Name of assignee or other owner or holder of mortgage -
Address of assignee(number and street city,state,and ZIP code) Drawer NO.a.o'.f •••
Does applicant own property in any other If yes,what county? - Who '.
� Card NO. yerty
musty in Indiana? rr1ytf�yv.�� t 1H� �./Q C '.7 ..
CI yes t>yevo )l 1 /� 1 a.J�e O�...,l, ...Q' � No
ll COUNTY AUG \Sr6
Deduction approved in the amount of: '°�
20_ 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
I I We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
Sig (owner's name) Date(month,day,year)
�� 0g�f�n�f 4
F resident address of applicant(number and sheet,dry state,and ZIP code)
c10 ' -sgni i p ed sv�nr (1746e)—P authorized by duly executed
of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code) .